INFECTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE
| Autor: | Steven J. Berman |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty business.industry medicine.medical_treatment Risk of infection Disease medicine.disease medicine.disease_cause End stage renal disease Pneumonia Infectious Diseases medicine.anatomical_structure Staphylococcus aureus White blood cell Bacteremia Medicine business Intensive care medicine Dialysis |
| Zdroj: | Infectious Disease Clinics of North America. 15:709-720 |
| ISSN: | 0891-5520 |
| DOI: | 10.1016/s0891-5520(05)70168-9 |
| Popis: | The patient with end-stage renal disease who is dependent on chronic hemodialysis presents a unique biologic model. In 1961, Schreiner was the first to note susceptibility to infection among patients with renal failure. 85 Of patients hospitalized with chronic renal failure, 60% acquired infections and 39% died from infectious causes. It was assumed that general debility from chronic uremia increased risk of infection and it was postulated that reversal of the uremic state would reduce the risk of infection. 64 Unfortunately, the prescription of chronic hemodialysis has not reduced the problem of infection; it has only changed the paradigm. 84 Dialysis superimposes myriad new problems onto patients already suffering relentless deterioration from underlying multi-system disease and poor wound healing. Common are problems associated with the intravascular connection, white blood cell and complement dysfunction from contact with dialysis membranes, iron overload, and exposure to bacteria and pyrogens from contaminated dialysis solutions or inadequately cleaned dialysis machines. Progress in solving the problems of these patients has been limited. A 10-year review of dialysis patients published in 1979 showed that infection was present in 25% of hospitalizations. 9 Major infectious problems included vascular access site infections, bacteremia, and pneumonia. Staphylococcus aureus was the most common pathogen. Infection contributed to 24% of total deaths. More recent experience finds little change from these earlier statistics. The vascular access site remains the source of bacteremia in 50% of patients. 52 S. aureus is still the most common pathogen in vascular access site infections and bacteremia. 67 Septicemia and pneumonia are as prevalent today as they were in the 1970s. 11,50 |
| Databáze: | OpenAIRE |
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